Few names in public health ring quite like Tom Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention. For more than 20 years Frieden has been a champion in controlling diseases worldwide, beginning with his work reducing tuberculosis incidence — including helping save more than 1 million lives in India — and his seven years as commissioner of the New York City Health Department. Among the city’s major health victories during his tenure, its number of smokers declined from 2002-2009 by 350,000.

Tom Frieden, director of the U.S. Centers for Disease Control and Prevention

APHA’s Public Health Newswire caught up with Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, to discuss the current and future state of public health. Photo by APHA

Since being appointed in 2009, Frieden has helped CDC launch numerous public health initiatives, including its Million Hearts initiative to prevent 1 million heart attacks and strokes over five years and its Winnable Battles campaign to address the leading causes of death and disability, including HIV, motor vehicle injuries, teen pregnancy, tobacco and obesity.

Public Health Newswire caught up with Frieden to find out where public health has made significant progress in the past year, where it needs to improve and what to expect from CDC in 2013 and beyond.

Q: At a recent Institute of Medicine conference, you said that public health worldwide is facing “a perfect storm of vulnerability and unprecedented opportunity for progress.” How great are the risks and rewards?

It is unacceptable to risk health and safety because we haven’t effectively supported proven solutions that we know will protect America’s health security and improve health across the globe. We live in a world where old, new and ever-more drug-resistant diseases pose an increasingly serious global threat. A strong public health system is our best defense against these threats.

Q: How does CDC’s work with nongovernmental partners such as the American Public Health Association lead to better health outcomes?

CDC works with APHA to help strengthen state, tribal, local and territorial public health systems throughout the U.S. This is critical because, while resources continue to shrink, our responsibility to protect health and eliminate health disparities is ever increasing. We have a strong partnership with APHA that will help ensure that our nation’s public health systems are prepared for all of the health challenges we face.

Q: You helped introduce ‘Winnable Battles’ to keep pace with emerging public health challenges. Which of these battles saw the most progress in 2012 and, conversely, which one needs the most improvement?

The good news is that we have made progress in each battle. One example is our progress in reducing health care-associated infections. We’re seeing declines in central line-associated bloodstream infections, surgical site infections and invasive methicillin-resistant Staphylococcus aureus infections. More health care providers are adhering to proven guidelines for preventing these infections.

And yet more needs to be done. C. difficile infections continue at a high level and the emergence of Carbapenem-resistant Enterobacteriaceae (CRE) infections in health care facilities is especially worrying.

Q: Over the last two years, CDC has awarded more than $170 million in Community Transformation Grants nationwide to support community-based prevention under the Affordable Care Act. Though CTG programs are relatively young, what impact have we seen from them so far?

The immediate impact is that people on front lines of public health have the resources to implement programs that we know work to prevent heart disease, cancer, diabetes and other leading killers. Awardees are using proven strategies that focus on reducing tobacco use, increasing physical activity, encouraging healthy eating and improving the linkage between community and clinical preventive services. In addition, awardees are building important coalitions to ensure broad participation and greater impact.

The CTG program is expected to improve the health of more than four out of 10 U.S. citizens, or about 130 million Americans.

Q: Healthy People 2020 lists four criteria to measure health progress: general health status, health-related quality of life and well-being, determinants of health and disparities. How successful have public health programs been in addressing these topics?

Public health has made great strides since our Healthy People initiatives and targets were first instituted in 1979. Vaccine-preventable disease has declined, there has been a substantial reduction in the number of infants born with neural-tube defects and cancer screening rates have improved. But there is a lot more we can and must do. Public policy can improve health and eliminate health disparities. We have a moral duty to ensure that everyone has the opportunity to be as healthy as possible.

Q: CDC launched the Million Hearts initiative to prevent 1 million heart attacks and strokes over five years. How much progress have we seen since its inception?

We have made important progress in the first year of the initiative. In 2012 we ran the Tips from Former Smokers campaign, the first-ever national paid media campaign, which showed the human impact of smoking in terms of disability and disfigurement with real stories from American smokers. During the campaign, calls to 1-800-QUIT-NOW doubled and visits to www.smokefree.gov tripled. This will prevent tens of thousands of heart attacks and strokes, and save thousands of lives.

We also learned important lessons in the past year about what works to improve blood pressure control and that it is possible, in small and large clinical systems, in urban and rural areas, to achieve blood pressure control rates of over 80 percent. Two Million Hearts hypertension control champions that we recognized, Kaiser Permanente-Colorado and the Ellsworth Medical Clinic in Wisconsin, helped their patients improve blood pressure control by incorporating sustainable changes into their daily practices, such as:

  • focusing on blood pressure control every day, with every patient, at every doctor’s visit;
  • maximizing use of electronic health records to track patient care over time, provide regular feedback to doctors and use prompts and reminders to improve care; and
  • using the full skills of every team member to identify and treat patients with high blood pressure, provide patient support and follow-up care, and help patients manage their medicines and follow a blood pressure control plan.

Meanwhile, control of high blood pressure remains at 47 percent nationally. We aim to identify, scale and spread the best practices from these high performers, working with our public health and clinical care partners to disseminate and implement them.

In the coming year, we want to strengthen ways in which public health and the clinical sector work together to prevent cardiovascular disease. We need to implement systems changes and focused clinical quality measures to simplify reporting requirements, protect patients and improve health.

Q: What new CDC initiatives can we expect in 2013?

We will focus on three core areas:

  • improving health security;
  • strengthening the link between public health and clinical care; and
  • doing more to prevent leading causes of death, disability and injuries.

Specifically, CDC is working with partners to eradicate polio and end forever this threat to all the world’s children. CDC will soon launch a new phase of our Tips from Former Smokers campaign; last year’s campaign was successful far beyond our ambitious expectations and helped many Americans quit smoking. We will push forward with the Million Hearts initiative to prevent a million heart attacks and strokes over five years.

Q: We’ve seen a big increase in social media adoption among federal agencies but CDC has been a leader in this space — especially on Twitter and Facebook. How has the agency’s online presence changed the way it talks with people?

Communication is critical to any public health strategy. We have to communicate the science of public health in ways people can understand to give them the information they need to make healthier decisions. And we have to communicate in ways that people actually use. Social media is an effective tool because it works like a feedback loop; we can reach the public directly and hear what they are thinking in near real time.

One of the biggest changes has been in the way I personally communicate with people. I launched my own Twitter account last year and have monthly Twitter chats on different public health topics. It has been interesting to see who participates: health departments, health care employees, public health workers and interested citizens.

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